So in case y’all didn’t realize, I am a transgender femme. I don’t identify with binary identities, but my body dysphoria tends to align with the experience of trans women so I seek medical procedures similar to them.

Recently, I had FFS, which is an acronym for facial feminization surgery. It was my first surgery, and it was a pretty intense experience!

I won’t go into details about the exact procedures I did or post before and after photos. Instead, I’d like to talk about the challenges I faced beforehand, especially with battling my insurance to get coverage. It’s a hard task, but something many people say is impossible. Spoiler alert: it’s not!

This post is focused around my personal experiences as a citizen of the USA with a private insurance plan, Anthem Blue Cross of California.

So I decided I’d like to pursue FFS late last year, and booked a few consultations. Unfortunately the NYC-based surgeons had a ridiculous wait time, but I did manage to see one. I decided to not limit my options to NYC, so I also spoke with Dr. Angela Rodriguez of the Bay area Crane Center.

I liked what I heard and her background was good, so I decided to pursue things with her. In retrospect, I should have definitely spoken with more surgeons, but it worked out in the end thankfully!

The initial consult was in February, and we ended up booking the surgery for June.

I started to assemble my letters. For those not in the know, as per the WPATH standards of care, there needs to be a letter from a mental health professional, usually your therapist, and a doctor. I obtained those, and also got a second letter from a therapist just in case. GALAP is a great org for this- they are a network of therapists who can write these letters for free!

Then came the insurance fight. I expected to get denied over and over, as Anthem’s clinical guidelines specifically states they won’t cover it. The initial authorization was indeed denied, so we appealed. And were denied again, so then came the second stage appeal.

By that time it was already May and Anthem denied my request for expedited appeal (naturally), so we moved the surgery till the end of July.

Of course, they then denied me again. This denial was final, which in insurance speak means we had to appeal to the state’s department governing health insurance plans.

Despite living in NYC my entire life, the department you go to is based on where the insurance is based, not you. So for me, that was the California Department of Managed Healthcare.

At least with California, these government orgs are very patient friendly, and often overrule insurance companies. I submitted my complaint online along with all the documentation, and let them do their thing.

For context, the complaint was filed on 6/5, and I got confirmation that my surgery was going to be covered 7/15. It was very exciting, even though I expected to win given past cases they’ve ruled on. By that point, my surgery was delayed till the end of August, so I had about a month to prepare.

At that point COVID was in full swing, so travel was a dicey proposition but I managed to avoid catching anything.

The surgery itself was uneventful, though blood loss forced us to split the procedure into two parts. It was not fun to have to deal with a swollen face not once but twice, but I managed to make it through.

I ended up spending about four weeks in San Francisco. A good chunk of that was spent in a hotel room with a sweetie who was amazing and took care of me. The last week was spent in an lovely AirBnB in Berkeley, which I highly recommend; I was crawling up the walls in that bland hotel after a few days!

I arrived home in September, and spent a few more weeks healing. Today my face is still slightly swollen and numb; I’m told that’ll last a while.

I guess the question is: was it worth it?

Short answer: yes.

Longer answer: it helped with my dysphoria for sure, which in the end was the goal. Before when I looked in the mirror I saw a guy. Now, I see me. My face doesn’t feel especially feminine, but honestly as a gender nebula I’m kinda okay with that.

I’ve very curious to see how things develop. Even though the remaining swelling is minor, it’s still enough to affect how I look in subtle but visible ways. In a sense my face is changing constantly, and I’m not sure what I’ll look like in the future.

I’m excited to find out, though! 🖤